Use of nonprescription topical steroids: patients' experiences

Topical steroids became available, without prescription, in the U.K. in 1987, with hydrocortisone 1% cream first being licensed for irritant contact dermatitis and reactions to insect bites. Since then the number of indications for nonprescription hydrocortisone use has increased and clobetasone has also become available as an over-the-counter (OTC) medicine. Little has been reported about how OTC steroids are used by community pharmacy clients.

We determined how OTC topical steroids are applied by patients, their demographic profile, the products used and the conditions treated, how frequently products were applied and how regularly purchased. The extent to which off-label use takes place was explored.

A patient-completed questionnaire study was used in 100 branches of a national pharmacy in Great Britain.

Questionnaires were completed and returned by 315 clients (16%). Eczema (192 cases, 61%) and dermatitis (66 cases, 21%) were the conditions most frequently treated. Nottingham Eczema Severity Scores calculated for 228 eczema and dermatitis sufferers shows that 164 patients (72%) had mild eczema. Those with more severe eczema were more likely to use clobetasone than hydrocortisone. The use of topical steroids outside OTC marketing authorization guidelines was widespread; however, no patient reported any adverse effects or deterioration in condition following steroid use.

OTC topical steroids are used mainly to treat eczema and dermatitis. Almost 50% of users treating these conditions exceed the limits of the rather restrictive OTC marketing authorization. Clinicians should be aware of the potential for adverse effects as a result of patients self-medicating with hydrocortisone or clobetasone for an extended period.